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The future of medicine: Telemedicine

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In the age were convenience matters more than anything else, telemedicine is one of the newest, most intriguing offerings available to doctors today. The concept of being able to shop from home and have it delivered the next day has been revolutionary. There is still many things that you still might want to go to a shop to see, feel and experience you self before you buy it. However, the convenience of ordering something from your home, office, or on the go allows an individual to spend more time doing something else. This is the kind of offering what telemedicine offers to medical practices. With the telemedicine platform, doctors have the convenience to talk, interact, diagnose and treat the patients without the patient having to physically needing to be there. This offer adds appeal to both the practice, and patients equally!

The options that come from the platform has the potential to improve medical care for the patient while making health care more accessible globally. The application of this new platform will allow patients to see doctors directly from their homes, offices, or even on the road, as needed. As long as the starting party and the receiving party have a smart device, the communication possibilities are endless. To explore these possibilities, we have to look at different case scenarios, exploring not only the benefits for the patient, but the cost effect model and implications it has for patients.

Telemedicine can be used in multiple ways, from follow up consults, to even acute illnesses. Let’s take a patient who went to work with a persistent cough and irritation in his throat since the morning. He decides that it’s not serious enough to take the day off, but still wants advice from his doctor either way. He goes online to the practice’s website and sees that the doctor has a free 15-minute block at 11AM, and decides to book a telemedicine consult. The patient carries on with his work, and come 11, heads to a secluded area, and logs in. From that point, all the patient has to do is launch the telemedicine waiting room, right from his internet browser in his office. The doctor joins in the call soon after seeing his patients and the telemedicine call is initiated. The doctor is able to pull the patients chart on his computer and via the web camera, is able to get a glimpse of the patient’s throat. After talking to patient, the doctor decides that this is not a bacterial infection, and decides to treat the symptoms with benzonatate and decongestants. The doctor sends the prescriptions over to the desired pharmacy and instructs the patient on the medication side effects and informs him to contact that practice again if his symptoms don’t improve. The doctor completes his notes, which include the CC/HPI, ROS, medications and plan, adds the diagnosis and CPT codes with the GQ modifier, and sends the claim before he sees his next patient.

This is the simplest form of the application that can be initiated in multiple ways. Telemedicine calls can be scheduled in advance by the front office, the patient can register themselves via a portal, and/or the doctor can initiate the call with an unscheduled patient as needed. As long as the patient has the link, they can open the meeting on their phone/tablet, or via any computer. The advantages of having a high definition, portable phone/tablet camera sometimes outweighs the inferior stationary computer camera. Being able to use these devices to facilitate a consult improves the quality of the encounter and helps facilitate a better diagnosis. The advantages for these types of calls allows the patient to continue with their daily routines and yet still have access to health care without spending half a day to travel to and visit a doctor. The advantages to the doctor include the fact that he will be able to fill his schedule, if open, and bill for a patient visit with minimal overhead. This is probably the most common and used application for telemedicine today. Allowing an application of this caliber allows the patient to maintain a relationship with his doctor, and save some time and money along the way. It also expands the practices by allowing empty slots on the calendar to be filled with telemedicine encounters.

Another widely used telemedicine platform is the Skilled Nursing Facility Carts (SNF Carts.) These carts started to become a popular choice to keep around in a nursing home setting for emergency consults. The advantages of a SNF cart are already evident in its practice. They have helped reduced the number of admittances to a hospital setting by allowing direct access to an overseeing physician via the cart. The technology allows the nurse to let the doctor hear heart and lung sounds through an integrated statoscope. It also has the capability of allowing the doctor to visually inspect wounds, lesions, larynx, eyes, and ear canal with the use of an exam camera. Finally, other attachments like an ECG, integrated pulse oximeters, and spirometry will give the doctor the ability to actively monitor the patient’s vitals from anywhere in the world. Studies have shown that ~25% of all patient admittance from a skilled nursing home facility could have been avoidable. While it’s true that most hospitalizations occur due to multi system dysfunction, SNF carts help reduce expensive admission costs by allowing physicians to intervene and screen before the decision to admit takes place.

Branching off the model where a nurse is able to reach out to a doctor for a consult, physicians have reached out to peers for consults using the same technology. A specific example of this is when an internal medicine doctor seeks out the help of a dermatologist. While the patient is waiting in the waiting for the internal medicine doctor, the doctor can reach out to the dermatologist and ask them to take some time to participate in a telemedicine consult. From that point, the internal medicine doctor or nurse can take a dermatoscope and allow the dermatologist to exam the lesions through the telemedicine consult. The dermatologist can have a consultation with the patient, prescribe necessary medications, and request a face to face follow-up consult on a following date. All of this while the patient was sitting at the internal medicine practice examining room. The model helps improve compliancy, and allows the patient complete access to medical care from a single facility.

Considering these models, there are many limitations to telemedicine that need to be addressed. For one, availability of the physician to be ready to take a call on moment’s notice might be a rare occurrence. Most telemedicine calls ideally should be scheduled ahead of time. Also, some informed decisions need a physical examination to be performed directly by the examiner to evaluate baseline changes.  Then there is the fear of over, or even under medicating a patient which can potentially be detrimental to that individual. With the aid of EMR’s and proper practices, these limitations can be minimized. The ability for doctors to see external medication and make real time decisions based on past medical history reduces any potential adverse interactions. For these reasons, telemedicine requires a new mindset of practice, one that is far from the traditional approach most doctors might be used to.

In an emerging world where internet has brought convince of doing anything from home, medicine is not far behind. With a proper platform, a practice can conduct doctor to patient, doctor to patient with a skilled nurse or even a direct doctor to doctor for patient consult situations. As reimbursements improve, including adding Remote Patient Monitoring systems to a patients’ regime, the possibilities for telemedicine are becoming more diverse and relevant. While telemedicine cannot replace traditional medicine, it can eventually help improve healthcare for patients by improving compliance. On a global setting, telemedicine can also open the possibilities for consultations for people in rural areas. Based on the different needs, telemedicine has been filling in the gaps for providers and allowing patients easier access to healthcare. The possibilities are endless, we’ve just tapped the surface!

Vipal Desai

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